Brighton Health Plan Solutions is seeking a Medical Director to lead utilization review and medical necessity determinations for self-funded commercial plans. You will support the CMO, maintain clinical decision quality, and guide nurse reviewers with defensible documentation and policy interpretation.
In this role, you will engage in peer discussions with physicians, adjudicate appeals, and participate in accreditation activities while ensuring compliance with URAC, NCQA, ERISA, and state
#J-18808-LjbffrMedical Director, Utilization Review & Policy in chapel hill at Unknown Company
This position is listed as full time and onsite.